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DALTON VENDEN
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1609261841
Individual Registrant: DALTON VENDEN
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
448 W MADISON ST WATERLOO, WI 53594-1325 US
Tel: 920-988-8312 Fax: --
Tel: 920-988-8312 Fax: --
Contact information for business:
448 W MADISON ST WATERLOO, WI 53594-1325 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1609261841
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | MI | 2601001252 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BOARD OF CERTIFICATION-ATHLETIC TRAINER CERTIFICATION NUMBER | 2000013236 | 01 |
